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Warning over "choking game"

17th April 2012

One in 16 teenagers in the United States plays a variation of the "choking" game, in which players self-asphyxiate in order to experience a "high" that comes with the sudden resumption of oxygen supplies to the brain.

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A new study published this week in the journal Pediatrics followed a group of eighth-graders, who are typically aged 13-14, in the Pacific northwestern state of Oregon.

Using data from the 2009 Oregon Healthy Teens survey of 5,348 adolescents, researchers analysed responses from questionnaires regarding lifetime prevalence and frequency of choking game participation.

They also compared it with participants' answers to questions about their physical and mental health, gambling, sexual activity, nutrition, physical activity/body image, exposure to violence, and substance use.

They concluded that around 6.1% of Oregon eighth-graders had played the "choking game," which is also known as "Knock Out", "Space Monkey" and "Flatlining," at some point in their lives.

Experts say the word "game" is misleading, as it masks the very real risk of brain damage, injuries and death.

There was no difference between girls and boys, but they found that children of either gender with a Pacific Islander background were more likely to play than white children. Among males, black boys were more likely to play asphyxia games than white boys.

While the results are largely in line with previous studies into the prevalence of asphyxia games across the United States, the study was the first to make a correlation between participation in such games and other forms of risky behaviour.

Teens who engaged in the choking game were also more likely to be sexually active and and to have misused substances, the data showed. Participants also had "other health risk behaviours," the researchers said.

It recommended that all teens receive a comprehensive adolescent wellness visit as recommended by the American Academy of Pediatrics. Such a visit offered an opportunity for healthcare providers to make a risk assessment, as well as to warn young people of the dangers of asphyxia games.

New Hampshire chief medical examiner Thomas Andrew said he was concerned over the study's findings, and those of similar surveys in recent years, as they offered evidence that a minority of teenagers, having played the game once, started to do it regularly.

Out of the Oregon study participants who said they had played the choking game, almost two-thirds of them said they had done it more than once, with more than 25% saying they had played it "at least five times."

Andrew, who was not involved in the Oregon study but who has studied asphyxia games, said that children who went on to repeat the choking game could progress to doing it alone with some kind of ligature to cut off air supply, which was even more risky than doing so with other people around.

Self-asphyxiation carries the risk of death by choking, but also of seizures and brain damage. Children have also died after sustaining head injuries from hitting the ground after their air supply was cut off.

Research team member Robert Nystrom said that the activity became more risky the more often it was carried out.

According to figures from the US Centers for Disease Control and Prevention, 82 media children died as a result of playing the choking game between 1995 and 2007, but Nystrom and his colleagues said that the true figure could be much more than that.

For example, deaths resulting from a child playing an asphyxia game alone could be reported as suicide.

University of Wisconsin-Milwaukee psychologist W. Hobart Davies said the activity, while nothing new among teenagers, could be more contagious in the Internet age. YouTube videos of children playing the game, for example, might suggest that is great fun and influence others to try it who otherwise might not have done.

Andrew called for children to be educated about the dangers of the "choking game" as part of programmes that teach them about drugs, alcohol and risky sexual behaviour.

One study children in Canada and Texas found that 40% of them did not see why the game might be dangerous, he said.


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